Insurance and DME

We all know insurance companies are evils but they have written policies and pre determination forms to determine what are the benefits are in covering the CPAP etc. When a newly diagnosed individual who is worried and unsure what to expect calls DME in following his doctor instructions and they prey on him that's bigger evil and coupled with greed too. In fairness to DME that I end up using him, not all of them are like that. When I first called the assigned DME, she sounded like a raging bull but when I asked : am I under any obligation to use your services? He's soften her voice and became like nice lady.

When someone call DME and looking for outright purchase, most of the time he has already called his insurance and verified the coverage. In my experience, my insurance approved outright purchase but didn't object rental or lease, they said this to me over and over. What the DME were telling me is that you HAVE to go thru rent to purchase, how can you not think of this as evil and greed.

As for me, I stumbled on a DME who can care less about rent and compliance. I outright purchased it and paid my 20% my share ant it's all mine no fees no compliance. For him being honest with me I tell you, he has Now earned all my business as lond as I am using the APAP.

Like I said not all DME are evils, some are honest but by far most are bullies and greedy and they prey on vulnerable ones.
As far as 99% of insurance requires compliance to purchase.... Well I can only say to anyone reading this is to call your insurance and you will be surprised when you ask whether they will approve an outright purchase from the start.

ThisGuy wrote:I got an approval letter from insurance. More confusion. Says I am approved for Continuous airway pressure device, start date 4/26/16 to end date 7/24/16, 6 units, code E0601. Also approved for tubing with heating element, start date 4/26/16 to end date 7/24/16, 1 unit, code A4604.

So, it seems that they have approved use of cpap for 2 months? I suppose this means they will review compliance in 2 months and re authorize? This appears to support the rental option, not a purchase option.

Why can't they just explain this in plain english?

They may be doing a rental to purchase conversion after compliance. That is what mine did. They rented at first, and once I completed compliance, they paid off the purchase price.

I had a horrific experience with my purchase. I won't go into the details, but I never got the same story twice. I called BCBSNC and the DME company multiple times. I paid a percentage, then got a refund, then got a bill.....it was ridiculous. It was finally resolved. Good luck to any who end up with a poor company. One day they showed up with an oxygen tank at my door.....it wasn't for me. Oops. Some companies have deep issues.

My DME company monitored me during my compliance period. I suppose they notified my healthcare carrier. Does anyone know if after the purchase is final, there is ANYONE monitoring me? I am registered with ResMed My Air and get that info daily, but is my info going to my health insurance carrier? I signed so much paperwork, I"m not sure if I signed anything about it or not. Just curious.

Why would anyone monitor you if they've got all their money?

But you can always check things with your insurance co...

SunnyBeBe wrote:Does anyone know if after the purchase is final, there is ANYONE monitoring me?

Well, probably not your insurance company. If your compliance period is over, which is really only to tell the insurance company that you are using the machine, and after your face to face with the doctor to determine that the treatment is beneficial, the insurance company doesn't care. Most use the preceding criteria to decide whether or not to continue your coverage past the original (usual) 90 days.

Your health care provider (Dr) is the one you would like to see monitoring your data, but chances are he isn't, either. After the initial follow up with the Dr, most folks find themselves on their own.

Self monitoring is probably best. Download SleepyHead, post your results, see what folks here think. Get SleepyHead and how to post here: https://sleep.tnet.com/resources/sleepyhead

Jay Aitchsee wrote:...Your health care provider (Dr) is the one you would like to see monitoring your data, but chances are he isn't, either. After the initial follow up with the Dr, most folks find themselves on their own.

Another sad and laughable aspect of my own experience. My first follow up was my last follow up as the Doctor had no interest in anything but the compliance data and stated as much (that and suggesting a titration study which sounded like an SOP cash grab for my local sleep lab and the required follow up visit). What the hell am I even seeing a doctor for when I know things are working OK? And I wonder why no one mentioned that my DS460P that they arranged for me had an autoset mode that could help me titrate on my own? Either they didn't know, or didn't want me to know. I would almost forgive the ignorance if that's what it was.

You're on your own - Except for people here and people like JediMark - thanks to you all for helping everyone through this maze.

amenite wrote:nd I wonder why no one mentioned that my DS460P that they arranged for me had an autoset mode that could help me titrate on my own?

possibly because the 460p is cpap only, not auto?

leaving aside the nitpicky detail that 'autoset' is a resmed thing.

amenite wrote: Another sad and laughable aspect of my own experience. My first follow up was my last follow up as the Doctor had no interest in anything but the compliance data and stated as much (that and suggesting a titration study which sounded like an SOP cash grab for my local sleep lab and the required follow up visit). What the hell am I even seeing a doctor for when I know things are working OK? And I wonder why no one mentioned that my DS460P that they arranged for me had an autoset mode that could help me titrate on my own? Either they didn't know, or didn't want me to know. I would almost forgive the ignorance if that's what it was.

The Auto mode on a DS460 is a limited auto mode that can only be used for a total of 30 days over the lifetime of the machine as I recall.

There has been chatter on here about whether it is possible to reset the machine so that you can use the Auto mode for another 30 day time period. If you are interested you might want to search the forum.

palerider wrote:

amenite wrote:nd I wonder why no one mentioned that my DS460P that they arranged for me had an autoset mode that could help me titrate on my own?

possibly because the 460p is cpap only, not auto?

Some might choose to insert a pithy remark here. I'll just advise you to look it up.

palerider wrote:

amenite wrote: is cpap only, not auto?

leaving aside the nitpicky detail that 'autoset' is a resmed thing.

Calling out a "nitpicky" detail is not leaving it aside. It's actually nit picking. Just in case anyone was misled (or expected any different). I'll send Resmed a check for tribute for my use of their no doubt trademarked nomenclature.

If Resmed or Respironics cared about our use of the correct terminology,
they would not work so damned hard to make it difficult to follow.

amenite wrote:

palerider wrote:

amenite wrote:nd I wonder why no one mentioned that my DS460P that they arranged for me had an autoset mode that could help me titrate on my own?

possibly because the 460p is cpap only, not auto?

Some might choose to insert a pithy remark here. I'll just advise you to look it up.

I wouldn't call an "auto trial" mode "autoset"

I'm sorry you bought the wrong machine, please don't take it out on others.

palerider wrote: sure sure, the 560 is the one with the full time permanent "auto"mode... which is the defining difference between it and the 460... so... think what you like, you're *obviously* the expert here

The expert - the one with the MD in the title and their staff - I would expected to know a bit more about this than a newbie and maybe take advantage of a feature like that instead of trying to shuffle me off for another costly sleep study. No worries though, I've lowered my expectations accordingly and moved on.